Decisions for Treatment of Neonates With Poor Prognosis: A Qualitative Study

Mamak Shariat; Fariba Asghari; Mahmoud Motevasel Arani; Nahid Farrokhzad; Yasamin Mohammadzadeh; Farahnaz  Mohammadi Shahboulaghi; Ameneh Abroun; Sayeh Mirzatavoli; Zohreh Janani; Fatemeh Sadat Nayeri

doi:10.18502/acta.v60i6.10041

Mamak Shariat Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
Fariba Asghari Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
Mahmoud Motevasel Arani Department of Islamic Maaref, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Nahid Farrokhzad Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
Yasamin Mohammadzadeh Breastfeeding Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
Farahnaz Mohammadi Shahboulaghi Department of Nursing, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Ameneh Abroun Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Sayeh Mirzatavoli Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Zohreh Janani Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Sadat Nayeri Breastfeeding Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/acta.v60i6.10041

Keywords: Poor prognosis newborns; Decision-making; Limits of viability

Abstract

Advances in medicine and medical technology have presented new moral challenges in terms of the management of extremely preterm infants and newborns with severe anomalies and advanced asphyxia. The aim of the present study was to examine the attitudes of health care providers and parents regarding decisions about the treatment of these neonates. The attitude of the Shia clerics is assessed in this study as well. In this qualitative content analysis research, data were collected through semi-structured interviews and focus group discussions (FGDs) with 98 participants, including physicians, nurse practitioners, medical ethicists, Shia clerics, and parents. Purposive sampling was employed by selecting those members of the community whom we thought would provide us with the best information and were also eager to participate. Data collection continued until data saturation was reached. Data analysis was carried out using conventional content analysis. Analysis of the data resulted in the extraction of 332 codes along with the following four categories: the necessity for preparation of a national guideline for the management of neonates with poor prognosis, the establishment of hospital neonatal-management committees, decision-making regarding the limits of viability, and parental support. This study affirms that the responsibility in terms of decision-making for neonates with poor prognosis lies upon hospital neonatal-management committees based on approved national guidelines such that decisions are made according to the aforementioned guidelines, Islamic moral codes, and scope of services available in medical units. This study dismisses individual decision-making and underlines the responsibility of a hospital neonatal-management committee in making decisions based on approved guidelines that conform to the regulations of national law and Islamic moral codes that determine the continuation or withdrawal of medical care and treatment of infants with a poor prognosis while bearing in mind that regulations, hospital facilities, resources, and other conditions differ in various hospitals within the country and with developed countries.